From the Hospital Clínico Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain (M.R.-M., L.M.-S., J.R.G.-J.); Department of Cardiology, Vrije Universiteit Brussel (VUB), Brussels, Belgium (C.d.A., G.-B.C., P.B.); Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France (F.S., M.H.); Hospital Clínic Universitario de Barcelona, Institut du Thorax, Barcelona, Spain (E.A., J.B.); CHU de Nantes, Nantes, France (V.P., J.-B.G.); Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba (J.C.-H.); CHU de Toulouse, Toulouse, France (P.M., A.R.); St. Bartholomew's Hospital, London, United Kingdom (P.L., R.S.); Clinica Universidad de Navarra, Pamplona, Spain (I.G.-B.); and Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.F.-K., T.K.).
Circ Arrhythm Electrophysiol. 2015 Aug;8(4):792-8. doi: 10.1161/CIRCEP.115.002871. Epub 2015 Jun 3.
It is thought that dedicated bipolar are more susceptible to T-wave oversensing when compared with integrated bipolar leads. This could be of extreme importance in patients with Brugada syndrome (BrS) because T-wave oversensing in this population is more frequent when compared with other implantable cardioverter defibrillator (ICD) recipients without BrS. We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of lead (integrated bipolar versus true/dedicated bipolar).
All patients diagnosed with BrS with an ICD implant in 10 tertiary hospitals between 1993 and 2013 were included in the study. A total of 480 patients were included (mean age, 45.6±14 years). During a mean follow-up of 74.9±51.7 months (median, 69; range, 2-236), 28 patients had T-wave oversensing (5.8%), leading to inappropriate shock in 18 (3.8%). All these events occurred in patients with true bipolar ICD leads (P=0.01) and in 2 patients it was solved instantaneously by changing the configuration from a dedicated to an integrated bipolar sensing configuration. In the stepwise multivariate models, only integrated bipolar ICD leads (hazard ratio, 0.34; 95% confidence interval, 0.171-0.675; P=0.002) was independent predictor of non-T-wave oversensing.
T-wave oversensing is a potential reason of inappropriate shocks in patients with BrS receiving ICDs. In the vast majority it can be solved by reprogramming. However, in some patients it still requires invasive intervention. Importantly, incidence is significantly lower using an integrated bipolar lead system when compared with a dedicated bipolar lead system and hence the latter should be routinely used in BrS cases.
与集成双极导联相比，专用双极导联更易发生 T 波过感。在 Brugada 综合征（BrS）患者中，这一点极为重要，因为与无 BrS 的其他植入式心脏复律除颤器（ICD）接受者相比，该人群中 T 波过感更为常见。我们旨在比较 BrS 患者中根据导联类型（集成双极与真正/专用双极）的 T 波过感发生率。
研究纳入了 1993 年至 2013 年间 10 家三级医院诊断为 BrS 并植入 ICD 的所有患者。共纳入 480 例患者（平均年龄 45.6±14 岁）。在平均 74.9±51.7 个月（中位数 69；范围 2-236）的随访期间，28 例患者出现 T 波过感（5.8%），导致 18 例（3.8%）出现不适当电击。所有这些事件均发生在具有真正双极 ICD 导联的患者中（P=0.01），在 2 例患者中，通过将配置从专用双极感应配置更改为集成双极感应配置，即刻解决了问题。在逐步多变量模型中，只有集成双极 ICD 导联（危险比，0.34；95%置信区间，0.171-0.675；P=0.002）是 T 波不过感的独立预测因素。
T 波过感是 BrS 患者接受 ICD 治疗时发生不适当电击的潜在原因。在绝大多数情况下，可通过重新编程解决。但是，在某些患者中，仍需要进行侵入性干预。重要的是，与专用双极导联系统相比，使用集成双极导联系统时发生率显著降低，因此后者应常规用于 BrS 病例。
